Technology and Compliance Challenges in the New Healthcare Landscape

During the COVID-19 pandemic, regulations on federal and state levels were relaxed to make telehealth and telemedicine more accessible. These were meant to be temporary measures for a desperate time, but the increased accessibility was also a convenience, a time saver for patients and in many ways, a superior way for doctors to provide care.

These measures also forced the adoption of technological enhancements, that, although long available, had not been used in healthcare. Now, as we return to normal life, we find the accessibility and convenience we’ve enjoyed difficult to give up. Regulations and guidelines need to be worked out. The future is uncertain, but what is sure is that the healthcare industry will never be the same. 

Progress recently hosted a webinar on this topic with our partner, Enqbator. In that webinar, Sujal Raju, Founder, CEO and President, Enqbator, spoke on How to Optimize your Online Patient Experience. To hear a video recording of Sujal’s expert advice in that webinar, click here.

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Changes in Healthcare Came Unexpectedly

It seems so foolish now, but there was a time that some office workers, like me, used to find a strange nobility in powering through a workday with a cold or flu. Playing hurt was the mark of a team player, right? So, like a concussed lightweight boxer in the final round, I’d stumble to my cubicle on three hours of sleep and a double shot of Dayquil. Was I contagious? You bet! “Contagiously committed,” I thought at the time, but probably no one was impressed by my fortitude.

In truth, it was always a bad idea to ignore sickness, but a pandemic drove home the notion that exposing others to your bugs is both reckless and wrong. As we tried to stay safe, face-to-face presence in an office very quickly became optional. This applied to nearly everyone’s office—including the doctor’s office.

The Technology Was Already in Place, but So Was Regulation

For the challenges set before us, technology offered solutions. Smart phones and broadband Internet could help us connect and communicate, remote monitoring systems (such as had been in existence since the 1970s) could be utilized to collect data, and we’d had a generation or so to get used to the idea of relating to each other through electronic means.

Regulation and the standard practices stood between patients and doctors. Healthcare providers had to rethink how they scheduled and sometimes, billed customers. Insurance companies had challenges with claims and payments. More than that, in the U.S., the laws and regulations that govern our healthcare system are layered with complexity, are bureaucratically structured and merely reactive to technical advancement. Nearly all healthcare, regardless of delivery method, is governed by laws and guidelines on a federal and state level, and it was not immediately clear how to deliver that care and remain compliant in this new modality. Among those, the HIPAA laws were garnering the most attention.

HIPAA Has Changed Through the Years and Remains Complicated

In the U.S., the Health Insurance Portability and Accountability Act (HIPAA) regulates delivery of healthcare. Signed into law in 1996, the act’s first intention was to increase the portability of healthcare for employees when changing jobs and also to combat fraud and waste in health insurance and healthcare in general.

In 2003, the first HIPAA Privacy and Security Rules were added. These were designed to guard privacy and other Civil Rights by limiting who, besides the patient, could receive patient health information. Even spouses needed to assign this right to each other before doctors could share details of test results, for instance.

That was actually the easy part. The murkier application of those rules involved determining what permission was needed—and what personal patient information could be used—for the fundraising, research and marketing of the hospitals, organizations and individuals that provided care.

Around 2009, the evolution of HIPAA continued with additional rules concerning electronic storage of records and incentives granted to third parties who could aid compliance by reporting back to providers what information they were receiving from them. The new legislation was called the Health Information Technology for Economic and Clinical Health Act (HITECH).

The Final Omnibus Rule of 2013 is the most recent and (as the name implies) final change to HIPAA. Rather than introducing additional legislation, it sought to fill in gaps, clarify grey areas and amend previous legislation that could not have included considerations for newer technology now used in patient care. If you want to learn more about the history of HIPAA, the HIPAA Journal offers a good summary of that history.

(By the way, if you read the entire HIPAA Journal article, they make the very compelling case for cloud storage. If you are considering a migration to the cloud, the Progress Sitefinity Cloud options are great choices for healthcare providers, or anyone wishing to streamline and scale their operations. Please read up on the Sitefinity Cloud compliance standards and contact Progress for more about our Cloud offerings.)

Desperate Times Called for Practical Measures

Very soon into the pandemic, in a sweeping move to ensure patients received the care they needed, state and federal regulations (including HIPAA) were relaxed to make telehealth and telemedicine more accessible. The relaxed standards allowed everyone access to remote care, but these were actually not that different from accommodations that had been available to those in remote rural areas for decades. It essentially just extended that privilege to everyone. At the same time, changes were also put in place that enable insurance providers to expand what treatments could be provided remotely, billed and paid. This included changes to Medicare coverage for telehealth and telemedicine.

These were to be temporary measures meant for a desperate time, but the increased accessibility was also a convenience, a time saver for patients, and in many ways, a superior way for doctors to provide care. Along with additional accessibility, these relaxed measures allowed for the adoption of technological enhancements that, although previously available, had not been widely employed in healthcare before them.

Desperate Times Called for Mergers and Acquisitions

Opportunities for providers of digital experience abounded, such that in the last few years we have seen exponential growth in startups and acquisitions to meet expected demand generated by this shift in modality. McKinsey estimates $250 billion in outpatient spending could potentially be shifted to virtual settings for home health services, office visits and urgent care. Amazon’s acquisition of healthcare provider One Medical for $3.9 billion is newsworthy proof of the scale of this trend and the seriousness of the disruption to the healthcare industry.

What to Expect in HIPAA, Healthcare and Digital Experience in the Next Few Years

No one can predict the future, but it does seem the genie is out of the bottle, and this time he’s wearing a lab coat and stethoscope. HIPAA, and other legislation, must change to clear the way for innovation. Industry generally moves faster than government, but there are signs that government is trying to catch up.

In December of 2022, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidelines on Online Tracking Technologies by HIPAA Covered Entities and Business Associates. This move is encouraging, as it shows recognition of digital sharing beyond just third-party cookies. The guidelines seemed designed to head off predictable trouble as healthcare entities, who do not understand the intricacies of marketing technology, partner with tech companies who are just learning that patient information requires more careful handling than the usual customer data they track or analytics and marketing.

Technologies will continue to adapt and provide answers. AI-driven chatbots, such as Progress NativeChat, will help patients navigate healthcare options and search for FAQ-type answers. Decisioning engines, like Progress Corticon, will apply business rules to the customer journey, helping determine eligibility and routing patients to the right options. And when secure file transfer is required, Progress MOVEit provides HIPAA-complaint options like no other.

Finally, the patient journey will be crafted and personalized by Digital Experience Platforms like Progress Sitefinity DX with the flexibility to connect to any new or existing system and present your message to your audience through every channel they touch.

We are optimistic about what lies ahead, and we are excited to be part of the future of healthcare. To learn more about what Progress can do for your healthcare organization, reach out to us. And to learn more about this topic, watch the webinar Progress recently hosted with Enqbator.

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